AB0366 RHEUMATOID ARTHRITIS PATIENTS WITH ≥6/28 TENDER JOINTS AND PATIENT AND PHYSICIAN GLOBAL ASSESSMENTS ≥3/10 HAVE SIGNIFICANTLY HIGHER LEVELS OF COMORBIDITIES WHICH MAY NOT BE RELATED TO INFLAMMATORY ACTIVITY, INCLUDING FIBROMYALGIA, DEPRESSION, FATIGUE, NECK PAIN, BACK PAIN, AND DEFORMED JOINTS
Authors: R. Hunter, N. Rodwell, T. Pincus
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Patients with rheumatoid arthritis (RA) are assessed in clinical trials and clinical care according to a core dataset and derived indices, which include tender (TJC) and swollen (SJC) joint counts, erythrocyte sedimentation rate (ESR), and patient (PaGA) and/or physician global assessments (PhGA). Many clinical trials require TJC and/or SJC ≥6 for enrollment, and improvement criteria require that SJC and TJC are 20%, 50%, or 70% better. It has been reported that TJC, PaGA, and PhGA may be elevated by comorbidities in the presence of little or no (or high) inflammatory activity, associated with high levels of fibromyalgia (FM), depression (DEP), fatigue (FT), back pain (Bpain), neck pain (Npain), and/or joints with deformity/limited motion (DJC). The likelihood and extent of elevations of RA measures associated with these comorbidities has not been extensively analyzed. FM, DEP, BPain, Npain, and FAT can be screened for on a multidimensional health assessment questionnaire (MDHAQ), and DJC can be included on a 28 joint count. <h3>Objectives</h3> To analyze RA patients seen in a routine care academic setting for possible elevations of SJC, TJC, ESR, PaGA and PhGA associated with positive screening for FM, DEP, FT, Bpain, Npain, and DJC. <h3>Methods</h3> A cross-sectional study was conducted at a routine care visit of RA patients to an academic rheumatology setting. All 7 RA core dataset measures were collected, including SJC, TJC, ESR, PaGL, and PhGL. The patient self-report measures were collected on an MDHAQ, completed by all patients in 5-10 minutes at this setting, which includes queries for FT, Npain, Bpain, and indices to screen for FM - FAST4 (fibromyalgia assessment screening tool), and DEP - MDS2 (MDHAQ depression screen). FAST4 and MDS2 agree more than 80% with reference standards but can be feasibly collected in routine care on a single questionnaire. Patients were classified into 2 groups according to clinically relevant cut-points for each possibly non-inflammatory variable, and the number of patients above and below these cut points compared by chi square analyses. <h3>Results</h3> In 125 RA patients with complete data, significant differences (p&lt;0.01) were seen for TJC &lt;6 vs ≥6, PaGA &lt;3 vs ≥3, and PhGA &lt;3 vs ≥3, according to positive FAST4 FM, DEP MDS2, Bpain and Npain, FAT ≥3/10, and DJC ≥6. No significant differences were seen according to ESR &lt;30 vs ≥30 or SJC &lt;6 vs ≥6, other than a difference in SJC &lt;6 vs ≥6 for patients with DJC &lt;6 vs ≥6, (Table 1). <h3>Conclusion</h3> TJC, PaGA, and PhGA, but not ESR or SJC, are associated with positive screening for FM, depression, back pain, neck pain, fatigue, and joints with deformity/limited motion, that may not result from inflammatory activity. These elevations may affect DAS28 and CDAI scores, interpretation for treat-to-target, and general management. It is feasible to screen for these comorbidities in routine care, which may enhance clinical decisions and outcomes. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.